• Georg Fuchs, Tharusan Thevathasan, Yves R Chretien, Julia Mario, Annop Piriyapatsom, Ulrich Schmidt, Matthias Eikermann, and Florian J Fintelmann.
• Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: Georg.Fuchs@Charite.de.
• J Crit Care. 2018 Apr 1; 44: 117-123.

PurposeTo evaluate the effect of a skeletal muscle index derived from a routine CT image at the level of vertebral body L3 (L3SMI) on outcomes of extubated patients in the surgical intensive care unit.Materials And Methods231 patients of a prospective observational trial (NCT01967056) who had undergone CT within 5days of extubation were included. L3SMI was computed using semi-automated segmentation. Primary outcomes were pneumonia within 30days of extubation, adverse discharge disposition and 30-day mortality. Secondary outcomes included re-intubation within 72h, total hospital costs, ICU length of stay (LOS), post-extubation LOS and total hospital LOS. Outcomes were analyzed using multivariable regression models with a priori-defined covariates height, gender, age, APACHE II score and Charlson Comorbidity Index.ResultsL3SMI was an independent predictor of pneumonia (aOR 0.96; 95% CI 0.941-0.986; P=0.002), adverse discharge disposition (aOR 0.98; 95% CI 0.957-0.999; P=0.044) and 30-day mortality (aOR 0.94; 95% CI 0.890-0.995; P=0.033). L3SMI was significantly lower in re-intubated patients (P=0.024). Secondary analyses suggest that L3SMI is associated with total hospital costs (P=0.043) and LOS post-extubation (P=0.048).ConclusionThe lumbar skeletal muscle index, derived from routine abdominal CT, is an objective prognostic tool at the time of extubation.Copyright © 2017 Elsevier Inc. All rights reserved.

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